Bottoming out implant after revision - is there something that can be done so it doesn’t happen again? (Photo)

I would suggest using mesh to reinforce the weak area of your lower breasts and to go with smaller implants that will not place as much weight on this weak area. Do not go larger.

Hi, thanks for your question. Following a face to face assessment the options are likely to include: using an alternative type of implant to reduce the risk of recurrence, change the plane of the implant (from below the muscle to above the muscle, assuming the implant is below the muscle), tighten up the skin at the bottom of the breast using a ‘melon slice’ technique, or to use an ‘internal bra’ to support the weight of the implant. This can take the form of using your own tissues, or reinforcing your own tissues with an absorbable mesh. A combination of techniques is likely to be required. I would recommend consulting a plastic surgeon with a specialist interest in aesthetic breast surgery.

I have to say, I really dislike this term 'bottoming out' (BO) because it introduces a stigma to something that seems to happen quite commonly to breasts whether or not they have implants or other cosmetic surgery and this appearance is not necessarily unattractive in my view.

However, BO seems to be in the common dictionary of words that are used in a association with cosmetic surgery and patients like yourself believe that they have had deficient treatment of some kind or another when they are really undergoing a natural biological process of skin stretching, just in the same way that skin on your tummy stretches when there is a baby inside. It happens more to some people than others because some of us have more stretchy skin and collagen than others.

You probably ended up needing the uplift in the first place because your skin had tendency to be rather stretchy.

This term should be renamed Lower breast stretch or 'LoBS'

LoBS essentially means that the curve of the breast below the nipple elongates and stretches and this changes the balance and appearance of the breast.

As previously mentioned it can happen to patients who have never had surgery at all but they have stretchy skin and often heavier breasts and under these circumstances it is called 'pseudoptosis'.

If your skin decides that it wants to stretch then it's going to and even revision surgery may not be able to guaranteeably prevent this from happening - so it's up to you whether you decide you want to have repeated operations to try and compete with your own biology or accept things as they are - and based on your photos I do not think the appearance is perfectly attractive and feminine and not at all bad.

Surgical manoeuvres to try would be a melon slice mastopexy (i.e. removing a melon slice shaped piece of tissue from the lower breast) and doing so in such a way as to try and fix the position of the under breast fold with some strong stitches to the deeper stronger layers of tissue adjacent to the ribs. This could still cause you discomfort, however and could still end up with stretch.

If you had smaller implants there would be less weight on the skin underneath the breast so this would reduce your chance of LoBS

Some surgeons will use an internal biologic membrane or mesh to try and support the lower part of the breast / implant, possibly in combination with placing the implant under the muscle. This certainly adds complexity and cost to such a procedure.

Another option could be to abandon the implants altogether, allow breasts to settle and see if you get any recoil of lower breast and then as a second stage look to enlarge the size of the breasts with fat transfer (fat liposuction from another part of your body and transferred to the breasts). Probably would need to still do a melonslice as part of this depending on how much the skin recoils. This has advantage that more fat can be added to the upper part of the breast relative to lower part.

Oliver Harley Plastic Surgeon